Running Head: LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 1

Life Skills Training to Promote Independence and Gain Self-Sufficiency:

An Occupation-Based Community Program at the Youth Resource Center in Salt Lake City

Tambra Farley Rasmussen

University of Utah
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 2

Needs Analysis (Part 1)

The purpose of this needs analysis and literature review is to determine how skilled

occupational therapy (OT) services can be applied to improve outcomes for the underserved

population at the Youth Resource Center (YRC). The YRC is an emergency shelter for

vulnerable youth ages 15-22. This needs assessment included data provided by the Sorensen

Legacy Foundation in their 2018 Impact Report (Sparrow, 2018) which discusses outcomes of

the YRC, through staff interviews, and semi-structured and informal interviews with the clients

as well as informal observation at the site. The evidence provided in this report illustrates the

benefits OT services will bring to this entity and population.

Description of Setting

Community Information

The YRC is located on the outskirts of downtown Salt Lake City (SLC), Utah. SLC is

Utah’s capital city, and the most heavily populated city in the state. According to the United

States Census Bureau (U.S. Census Bureau, 2017) SLC had a population of approximately

200,544 as of July 1, 2017 with youth under the age of 18 making up 21.2% of the population

(U.S. Census Bureau, 2017). The population of the city is predominately Caucasian with 72%

percent of people noted to be white, followed by 21.6% of Hispanic or Latino decent (U.S.

Census Bureau, 2017).

SLC is a well-known tourist destination due to its proximity to a plethora of outdoor

activities including snow skiing, its wide variety of restaurants, and its rich cultural and

educational opportunities and museums. SLC is home to Temple Square which is famous for

beautiful gardens in the summer and Christmas light displays in the winter. Temple Square is
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owned by the Church of Jesus Christ of Latter-day Saints (LDS) and provides a hub for LDS

church members world-wide. Salt Lake County’s predominant religion is the LDS church with

approximately 51.2% of people in the county claiming membership (Canhan, 2014). The LDS

church and its history are central to the culture of the area with many people in the city claiming

ancestry to the Mormon Pioneers that settled the area in 1847 (Tullis, 2014).

Mission of the Agency

The YRC is under the umbrella of Volunteers of America (VOA, Utah.) The VOA

mission statement is “We have always been and will always be here to help. Our mission is to

reach and uplift all people, touching their body, mind, and ultimately their soul” (VOA, Utah).

The YRC does not have their own official mission statement, however, Carlos Garcia, their

Program Manager stated in an interview that his personal mission for the facility is to “provide

consistency and structure using peer modeling in order to help the youth get on their feet in three

to six months” (C. Garcia, personal communication, September 17, 2018). The YRC is intended

to be an emergency shelter, however many end up staying at the facility for years. Carlos is

working to improve turn-around times to help clients obtain permanent housing as soon as

possible. Clients at the YRC are given opportunities to receive vouchers for rapid rehousing, but

in order to qualify, they must meet certain criteria. Overall, the culture of the agency is a desire

to help the clients gain the skills and resources they need in order to become independent.

Services Provided

A variety of services are provided at the YRC which is considered a community-based

setting. They have a total of 30 beds for clients to stay the night, they provide three meals a day,

and clients especially interested in receiving housing vouchers are able to enroll in a self-reliance

program (SRP). The YRC offers free legal advice from a lawyer who is paid through a grant and
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employs three licensed clinical social workers to directly work with the clients. Additionally, the

YRC has a relationship with many community organizations such as the Cornerstone Counseling

Center, The 4th Street Clinic, the University of Utah School of Dentistry, and Odyssey House.

For services they are unable to provide in-house, the YRC can put their clients in touch with

someone from a relevant organization. Clients who are on an SRP are required to attend daily

group activities. Group sessions may include topics such as learning coping skills, safe sex

practices, communication skills, vocational rehab, lesbian gay bisexual transgender queer

intersex asexual (LGBTQIA) discussion groups, job readiness, resume writing, and creative

writing to just name some of the possibilities. Additionally, the YRC provides showers and a

place to do laundry as well as clothing items as needed. They can also arrange transportation for

the youth to go to job interviews or other important appointments (C. Garcia, personal

communication, September 17, 2018).

Staff Disciplines

Most of the staff members in leadership roles are clinical social workers. This includes

both the Director of Youth Services and the Program Manager. Additionally, the YRC employs

three social workers in clinical roles to work directly with the youth. One works full time, and

the other two are part time. Youth Advocates who work on the floor typically have a bachelor’s

degree in a field of their choice, but this is not required. If a person appears to be a good fit for

the position and population, a degree is not necessary. A position as a youth advocate provides

valuable experience for people pursuing a degree in a social work or related areas. Much of the

work accomplished at the YRC is done through background-checked volunteers. For example,

all meals are donated, prepared, and served by volunteers. Volunteers also run many of the
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 5

group activities as well as collect and sort donations. Volunteers come from a wide variety of

professional backgrounds.

Funding Sources

The YRC is a non-profit organization that is mostly funded by private donations.

According to the Director of Youth Services, Cydnie LaCour, approximately 80% of donations

are from private funds (C. LaCour, personal communication, September 10, 2018). LaCour

notes that the rest of the funding for the YRC is from a variety of donors including the United

States Department of Housing and Urban Development (HUD), state and federal funding

sources, an Emergency Services Grant, and Intermountain Healthcare (IHC) provides funding to

pay for a full-time social worker as part of the 20% of funding that is not from private donors.

History of the Agency

The VOA was founded in 1896 by Maud and Ballington Booth with the Utah extension

being opened in 1907 (VOA, Utah). Initial services included a hotel for the needy and

medication distribution (VOA, Utah). By the 1920’s, the VOA was also providing an

employment agency, thrift store, and an emergency shelter (VOA, Utah). Unfortunately, due to

the Great Depression, the Utah branch was forced to close in 1929 (VOA, Utah). The Utah

branch of VOA was re-opened in 1986 with a detox center (VOA, Utah). VOA services in Utah

have since expanded to include homeless shelters, substance abuse cessation programs, mental

health services, and services to protect against domestic violence (VOA, Utah).

The YRC was originally taken over by VOA in 1999. The YRC was previously located

on State Street in downtown SLC but moved to the current location two years ago (A. Dover,

personal communication, September 27, 2018). The previous location was only open from 9:00

AM to 5:00 PM and was not an emergency shelter. By moving to a larger location, the YRC was
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 6

able to add 30 beds for overnight shelter. Due to the new center, the YRC has also been able to

spend the last two years expanding the services provided (D. Rodriguez, personal

communication, September 27, 2018).

Current Policy Issues

Economic. Since the YRC is mostly funded by private donations, they do not experience

as many policy issues as organizations that are government-funded may, however they do have

to work within a limited budget and rely on grant money to fund some of their positions. Right

now, grant money pays a lawyer for 10 hours of services a week, and a grant from IHC pays for

their full-time social worker who is instrumental in running the SRP’s for those looking to obtain

housing vouchers. Without grant money, those two valuable services may not be fundable.

Political, Social, and Demographic Factors. One significant concern that was expressed

by multiple staff members was about the foster care system. According to LaCour, up to 70% of

the clients in the shelter at any given time have been touched by the foster care system (C.

LaCour, personal communication, September 10, 2018). Per Garcia, many of the youth at the

YRC have either aged out of foster care, ran away from an abusive foster family, or were kicked

out of the home by their foster family (C. Garcia, personal communication, September 17, 2018).

Garcia feels that the foster care system is failing teens by not providing them with quality

placements where they will be safe. Additionally, there are not many good programs to help

youth transition from the foster care system into mainstream society. Here in Utah, the YRC is

one of the few places those who age out of the system can go for help.

When asked about internal policy issues, Carlos Garcia was mostly frustrated with their

current policies for suspensions. Certain infractions such as substance use, fighting, or

inappropriate physical contact with a staff member may result in a suspension. This is
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concerning to Garcia because the clients that are most likely to be suspended are often the clients

that need services the most (C. Garcia, personal communication, September 17, 2018).

Frequently, those that are suspended rely on the YRC to provide them safe housing and meals.

Clients with mental health diagnoses or a history of substance abuse receive suspensions due to

behaviors that may be attributed to their condition and are often the most vulnerable because

they may not have support outside of the YRC. Essentially being suspended for a long period of

time is going to cause them to lose progress that they have made (C. Garcia, personal

communication, September 17, 2018).

Geographic Factors. The YRC is located in a generally conservative state with a

significant LDS population. Approximately 18% of the population at the YRC (Sparrow, 2018)

identify as LGBTQ. Some LDS parents are unwilling to accept that their child identifies as

homosexual. For this reason, some of the clients at the YRC are there because they were kicked

out of their homes due to their sexual identity (C. Garcia, personal communication, September

17, 2018).

Target Population and Who They Serve

The target population for the YRC are youth aged 15-22 that are homeless or in danger of

becoming homeless by HUD standards (Sparrow, 2018). The following data is from the intake

process at the YRC and illustrates the population served:

 For the 2017-2018 Fiscal Year (FY) the YRC served 715 individuals

 100% were low income

 35% were female, 65% male

 9% are aged 15-18

 18% identify as LGBTQ

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 15% are parents (Sparrow, 2018).

According to Andrea Dover, the most often seen medical diagnosis for clients at the YRC

include schizophrenia, trauma, suicidal ideation, substance use, and depression (A. Dover,

personal communication, September 24, 2018).

Future Plans for Program Development

According to Garcia, he would like to see the program incorporate more physical activity

for the youth, and more educational opportunities to learn life skills (C. Garcia, personal

communication, September 17, 2018). Garcia would especially like to see a boxing group to

help mitigate some anger for the clients by having them particpate in a sport that allows them to

take out their frustrations in a gym rather than on other people. He is working to expand the

number of groups offered, and to widen the variety of topics. According to Andrea Dover the

clients need to learn more life skills, and she would like to find a way to incorporate this into

future program development (A. Dover, personal communication, September 24, 2018.) Overall,

the staff would like to find more effective ways to engage the clients in the activities and

programs provided in order to help the clients gain the skills and self-sufficiency needed to live

independently as well as put them in touch with the resources they may need to become as

healthy and stable as possible.

Programming Strengths and Areas for Growth

Staff Perspective

One-on-one semi-structured interviews were conducted with three staff members.

Interviews were completed in order to learn the strengths and weaknesses of the programs

offered at the YRC from the perspective of the staff members that work directly with the youth.
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 9

Members of the YRC team were very welcoming and eager to share their perspectives and gave

great in-depth information regarding the programs offered and how they would like to see the

YRC continue to grow in the upcoming years.

Cydnie LaCour is the Director of Youth Services at the YRC, and she feels that the self-

reliance program is a strong point in the services provided. This program serves a total of 15

clients at a time who are guaranteed a bed at night as long as they are complying with the

requirements of the SRP. As part of the SRP, clients work one-on-one with a youth advocate to

set and work on self-sufficiency goals and meet with a social worker weekly. Those who fully

participate in this program and take advantage of what it offers frequently obtain jobs and rapid

rehousing vouchers. LaCour also sees the relationship the YRC has with other organizations as a

positive. Through these relationships, the YRC can get their clients in touch with resources for

medical help, dental services, mental health facilities and substance abuse programs.

A concern of LaCour’s is employee burnout. This population is emotionally draining to

work with, and they have high turnover at the facility, especially in the youth advocate positions.

Having consistent staff members is important because it gives the employees valuable

opportunities to build relationships with the clients. Additionally, the YRC is meant to be an

emergency shelter for short stays, however some of the clients have been there for over two

years. Finding a way to get clients to a point of self-reliance is a concern, especially when they

get close to aging out of the YRC on their 23rd birthday.

Carlos Garcia is the current Program Manager, and previously worked as a Youth

Advocate. He feels that the shelter is moving in the right direction regarding the services

provided but is concerned that clients are spending too much time there. Ideally, he would like

clients staying at the YRC for three to six months at the most. He also is concerned that the
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 10

clients there typically get very little exercise. He would like to see physical fitness incorporated

in the groups offered. He sees the benefit that exercise could have on mood and anger

management but has not yet been able to bring in group leaders to help with this. Right now,

groups run from 3:00-5:00 every day, and unless a client is on an SRP, they are not required to

attend. He would like to see more participation in groups. Additionally, right now, there are

only a total of 2-4 different groups offered during this time slot. He would like to have a greater

variety of choices available for the youth to choose from.

Andrea Dover is currently working as the night time social worker at the YRC. Prior to

receiving her Master of Clinical Social Work degree, she worked as a Youth Advocate. She has

been at the YRC since it opened at the new location two years ago and personally knows many

of the clients there. She notes that at the YRC, they can do low-level case management, but

overall, it’s not enough for many of the client’s there. For example, they cannot distribute

medications, but some of the clients are unable to effectively manage their medications on their

own. Some of the strengths she notes are that minors are guaranteed a bed in the shelter, and that

their intake process includes assessments to determine the extent of the services needed. In the

past, some of the clients at the shelter were not in need of services and were just there to hang

out with friends. Though this still occurs, it’s not as rampant as before. They use the Casey Life

Skills Assessment to better assess the client’s ability to communicate effectively, take care of

themselves and their environment, and their ability to manage their finances. They also use the

Youth Outcomes Questionnaire to learn about their feelings and behavior.

Client Perspective

The Canadian Occupational Performance Measure (COPM) which is a semi-structured

interview that is used to determine, rate, and quantify performance problems from the client’s
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 11

perspective was administered to total of four clients, three males and one female. They ranged in

age from 21-22. Those who completed the COPM, consistently identified the following

occupational performance problems: Keeping jobs, finding and keeping housing, and having

more meaningful relationships with family and/or close friends. With the help of the YRC, the

youth interviewed who want to gain employment and have gone through with the application and

interview process have been able to obtain jobs but are having a hard time abiding by the rules of

their workplace and finding reliable transportation to get to the site. In one interview, client #1

stated that “my bike was stolen, so now it’s hard to get to work” (Client #1, personal

communication, September 19, 2018) client #2 noted that “I act impulsively and sometimes says

things my boss doesn’t want to hear” (Client #2, personal communication, August 31, 2018).

This led to him being fired from his most recent position. Of the four who completed the

COPM, only one was currently employed. All four stated that they want to qualify for housing,

but only one of them was actively participating in the programs necessary to do so. All four of

the clients who agreed to completing a COPM identified at least one disability. Two have

learning disabilities, one has schizophrenia, and one has hemophilia that has led to multiple

hospitalizations. Client #3 has a young son that he is rarely able to see (Client #3, personal

communication, August 31, 2018), and client #2 was recently released from jail after spending 6

months incarcerated for a parole violation (Client #2, personal communication, August 31,

2018). All four have stinted relationships with their biological families but had some degree of

contact. Reasons for homelessness included being kicked out, family living out of state, family

unable to support them financially, and one client’s mother is also homeless.

Those that completed the COPM were asked about what the YRC does well. All of them

feel like it is much better than living on the streets or living in other shelters. Three of the four
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had nothing but great things to say. They love the staff, feel that their best interests are always

kept in mind, and that the YRC is doing its best to help them find jobs, permanent homes, and

get the medical attention they need. Client #1 complained about the drama of living there. He is

tired of the noise, fighting, and general “nosiness” of the other clients indicating that the sensory

needs of some clients are unmet (Client #1, personal communication, September 19, 2018).

Informal interviews, and observation have been completed on an on-going basis. From

these interviews and observations, the problems with employment and housing continued to be

top concerns for the clients served, however only a handful of those I spoke with are actively

doing anything to improve their current situation. A few of those I spoke with are actively

pursuing college degrees, however they expressed concerns about reliable transportation, and

being able to maintain balance between work, school, and a social life.

Graduate Student Perspective

The combination of semi-structured interviews, informal interviews, data provided in the

Impact Report, and client observations in a variety of situations was utilized to form an educated

opinion regarding the strengths and weaknesses of the current programs available at the YRC.

The staff at the YRC is continually looking at ways to improve their service delivery and are

open to implementing changes that will increase the success of their organization. They are very

open to including occupation-based services to improve client outcomes.

Strengths. The YRC does an amazing job of creating a safe space for homeless youth

and taking care of their immediate human needs. They foster a culture of inclusion which is

apparent in the interactions of the clients with each other as well as in the interactions between

staff and clients. According to Garcia, they have had clients from all over the nation that have

heard about their program and traveled to Utah in order to find a safe space (C. Garcia, personal
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communication, September 17, 2018). The YRC has fostered relationships with a variety of

other organizations in order to provide necessary services to their clientele. Though somewhat

limited in the services they can provide on-site, they have a wide network of resources to put

their clients in touch with. For the youth that choose to participate fully in a SRP, they have a

relatively quick turn around from homelessness to being housed. Additionally, those who want

jobs are able to find them with the help of the YRC which helps with resume writing,

applications, clothing for interviews, and provides bus tokens for transportation to interviews.

The lawyer on site is able to provide advice on a variety of legal concerns that are faced by this

population. These include emancipation, as wells as advice regarding legal concerns and

convictions. In some cases, he is able to remind the youth of important court dates and arrange

for transportation. The YRC ensures that basic human needs are met. They are able to provide

shelter, meals, clothing, access to hygiene items, and emotional support from trained adults.

Weaknesses and barriers. Most of the clients at the YRC are not progressing towards

self-sufficiency. They rely on the shelter to provide them with everything they need and become

comfortable with this arrangement, however it is not a permanent solution, and if they are unable

to become self-sufficient, they will eventually find themselves on the streets. When asked what

a typical day looks like, most of the clients noted that they “hang out” or “walk around” most of

the day. Their engagement in meaningful occupations is generally very limited. Many of these

youth have a limited knowledge of basic skills such as personal finance, housekeeping, cooking,

or making and keeping appointments. Some have never learned to use public transportation or

how to drive. Someone has always done these things for them, and they are in a state of stuck.

Additionally, few of them participate in meaningful recreational activities and are not typically

pursing their interests. Lack of participation in meaningful occupations is due in part to many of
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the youth being in survival mode, and just trying to get by, but for longer term clients, it appears

they are in the midst of a cycle where their needs are met, so they are doing little to change their

situation as they are comfortable in the moment. Some clients also were found to take the

services they are receiving for granted. For example, some of the youth throw away clothing

rather than washing it because they know they can get more for free.

Group activities have great potential to be highly beneficial, however often groups that

are educational are not well attended. The clients prefer activities that they see as fun, such as

browsing the internet in the computer lab and often avoid less enticing activities. Clients who

are required to attend group activities as part of a SRP are not obligated to participate. All that is

necessary to meet their requirements is that they show up. Often clients will sit and play on their

phones or sleep. Additionally, there are few groups that consistently teach skills to help client’s

become successful outside of the YRC. Additionally, the volunteers teaching these courses do

not always have the education and resources to help clients with special needs. OTs are in a

unique position to teach life skills while also being able to do in depth activity analysis to

determine what components of an activity are difficult for a client and help them build the skills

they need in order to be successful.

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Evidence-Based Practice (Part 2)

This literature review was completed in order to determine the most critical occupation-

based needs of the clients who are accessing the resources at the YRC. The American Journal of

Occupational Therapy (AJOT) and the University of Utah Spencer S. Eccles Health Sciences

Library were utilized to find relevant articles. Search terms used included: Occupational

therapy, mental health, foster care, learned helplessness, life skills, homelessness, youth,

homeless shelter, young adult. AJOT provided a total of six articles written within the last 10

years that met the established criteria, one of which was a pilot study to build evidence towards a

second article that was also utilized. The University of Utah Eccles Health Sciences Library

produced a total of seven articles that were written within the last ten years that lend support to

this literature review. Articles were deemed appropriate if they included one or more of the

search terms in a context that was also applicable to the services provided at the YRC or the

client population at the YRC.

Common Deficits or Diagnoses Found in the YRC Population

Peer-reviewed articles were utilized to better assess health-related concerns impacting the

occupational performance of a young homeless population. Gronski et al. (2013) proposed that

childhood toxic stress can put young adults at risk for mental and physical health problems

throughout their lifetime. These stressors include childhood traumas such as witnessing or being

a victim of abuse or crime. Many of the youth living at the YRC have experienced toxic stress in

the past and continue to experience it because being homeless is extremely traumatic. Living

with toxic stress is concerning during formative years where the brain is still developing

(Gronski, 2013). The overuse of the body’s stress response system can lead to increased

prevalence of adult diseases including depression, anxiety, mental illness, decreased cognition,
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cardiovascular disease, diabetes, and hypertension to name a few. Exposure to toxic stress also

causes adolescents to become more likely to drink alcohol, use tobacco, use illicit drugs, and

participate in risky behaviors such as gambling as compared to youth that have not been exposed

to toxic stress (Shonkoff et al., 2012). Read, Roush, and Downing (2018) discuss the transition

from adolescence to early adulthood and the need for interventions for youth in this demographic

because they are at high risk for developing serious mental illnesses including psychosis and

suicidal ideation. Read et al. (2013) confirmed the need to address cognition, self-esteem, social-

functioning, and occupational function with this population in order to improve occupational

outcomes which are often poor for this demographic. Toglia and Berg, 2013, added that that

“executive cognitive impairments are a major contributor to the underlying learning, behavioral,

and psychosocial deficits observed in at-risk youth (Toglia and Berg, 2013, p.1).” Medalia,

Saperstein, Huang, Lee, and Ronan (2017), stated that cognitive impairments negatively impact

education and vocational results for homeless youth. Overall, youth who have experienced

significant toxic stress are more likely than peers who have not experienced toxic stress to

develop serious mental illness, have cognitive disabilities, and to abuse substances.

Additionally, they are at risk for dropping out of school, participating in gang activity, being

incarcerated, or becoming single parents

Common Barriers to Occupational Performance in a Homeless Population

As previously discussed, toxic stress is a major risk factor for a variety of deficits and

diagnoses that cause barriers to occupational performance for young adults. Some of these

include the development of substance abuse disorders, mental health disorders, and diagnoses

that affect cognition along with a slew of other chronic medical conditions that all have the

potential to affect task performance. Another concern for this population is learned helplessness.
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 17

According to Gomez, Ryan, Norton, Jones, and Galán- Cisneros (2015), the child welfare system

may inhibit the development of self-efficacy. This pertains to children raised in foster care as

well as those relying on homeless services. The youth living in the American Southwest who

were interviewed by Gomez et al. (2015), expressed that they have not learned the life skills

necessary to thrive in the real world. Out of the 134 young adults interviewed, only two felt as

though they were well prepared for adulthood (Gomez et al., 2015). According to Courtney,

Lee, and Perez, (2011), who did research in the Midwestern United States, 28% of former foster

children interviewed felt prepared for adult life. Though this statistic is more promising than that

found by Gomez et al. (2015), it is still concerning as fewer than one-third of those surveyed are

confident in their ability to function successfully as an adult. Often youth in foster care receive

government aid checks or other direct services that they come to rely on and have limited

knowledge of how to take care of themselves once these resources are no longer available

(Gomez et al., 2015). Additionally, youth in foster care become accustomed to foster parents

and other case managers taking care of their needs, so they do not learn how to do for themselves

(Gomez et al., 2015). Paul-Ward and Lambdin-Pattavina, (2016) added that frequently, agencies

supporting young adults do not have a large enough staff to individually assess each client’s

needs, so the staff does everything for the youth rather than helping the youth learn to complete

important tasks for themselves. This contributes to the problem of learned helplessness as the

youth learn to rely on others to problem solve for them. According to one client interviewed by

Gomez et al. (2015), when an individual is in foster care, they depend on other people to do

things for them. Once they are in the real world, people get confused and lost.

The YRC provides many of the same services that youth receive while in foster care, so

an adult, such as social workers and youth advocates continue to take care of their needs for
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them. One of the two youth interviewed by Gomez et al. (2015) who stated that they felt

prepared for adulthood, attributed this to good foster parents who helped them learn the skills

needed to be independent.

Overwhelmingly, those interviewed by both Gomez et al. (2015) and Courtney et al.,

(2011), stated that they needed to learn life skills in order to be successful. These include topics

such as vocational skills, skills to finish high school as well as college preparation information,

social competency, sexuality, financial literacy, health and wellness information, housing

services, learning to drive or use public transportation, and help navigating systems such as

healthcare.

It is clear that programs to develop life skills are important to young adults who are aging

out of foster care or are receiving homeless services; however, according to Paul-Ward (2009),

classes focusing on independent living skills were often scheduled inconsistently. Furthermore,

youth interviewed at one facility stated that they did not know when classes were available, or

they did not receive notification far enough in advance to attend. Those who would have liked to

attend were disappointed when they learned that they missed out on opportunities to participate

in life skills courses. Another problem noted, is that there is frequently no good way to insure

participation. In cases where mandatory participation was implemented, youth quickly learned

that there were no actual repercussions for not attending. Inconsistent scheduling, combined

with poor notification of upcoming classes, and no repercussions for absenteeism lead to

unsatisfactory attendance of life skills classes while leaving youth frustrated, and feeling

unprepared for adulthood (Paul-Ward, 2009.)

Occupational Therapy’s Emerging Role

LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 19

Working with homeless youth is an emerging and important practice area for OTs.

According to Lloyd, & Bassett (2012), OTs are able to complete occupation-based assessments

and help clients engage successfully in their life roles. By using a strengths-based approach, and

engaging homeless clients in meaningful occupations, mental health as well as a sense of

wellbeing can be improved (Lloyd & Bassett, 2012). Unique perspectives gained from using OT

models as part of service delivery make OTs a valuable resource when working with a homeless

population (Lloyd & Bassett, 2012). According to Paul-Ward and Lambdin-Pattavina (2016),

OT practitioners have the skills to intervene on both the community and individual levels while

using the Occupational Therapy Practice Framework (OTPF) to guide interventions.

Occupational Therapy Interventions to Improve Transition to Adulthood

Two specific intervention approaches were found in the literature to be beneficial to at-

risk young adults and adolescents. These intervention approaches include a cognitive

remediation approach researched by Weiner, Toglia, and Berg initially as a pilot study, then a

larger randomized controlled study was conducted by Toglia and Berg the following year

comparing at risk youth with typical peers (Weiner, Toglia, & Berg 2012; Toglia & Berg, 2013;

Medalia et al., 2017). Life skills training was addressed by a variety of authors as a beneficial

intervention for youth transitioning to adulthood (Buchert, 2014; Courtney et al., 2011; Keenan,

King, Curran, & McPherson, (2013).

Weiner et al. (2012) and Toglia and Berg, (2013), used the Weekly Calendar Planning

Activity (WCPA), which is a performance-based assessment of executive function to measure

executive function of at-risk adolescents aged 21-26. Adolescents with well-developed

executive function are better able to navigate the demands of adulthood (Weiner et al., 2012).
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 20

By observing the strategies a participant uses to complete the WCPA, a trained OT can

determine what aspects of executive function are problematic for the client. The OT can then

use this information to plan interventions which have the potential to increase performance in

broad areas (Toglia & Berg, 2013; Weiner, Toglia & Berg, 2012) “The WCPA analyzes how a

person manages and copes with a complex and cognitively challenging activity and involves

following and organizing a list of appointments or errands into a weekly schedule while keeping

track of rules, avoiding conflicts, monitoring passage of time, and inhibiting distractions.

Because performance on multiple-step activities such as the WCPA requires coordinating and

integrating various cognitive abilities, this assessment provides the opportunity to observe how

an individual manages a cognitively challenging task (Toglia, 2015).” Medalia et al. (2017, p.

864), implemented a community-based approach to cognitive skills training with participants

with a variety of disorders. They found that after 13 sessions, the majority of participants

showed significant improvement in executive function, verbal memory, working memory, and

processing speed as well as improved mental health outcomes which generalized to improved

function in the community (Medalia et al. 2017.)

Life skills training is a very broad topic, but for the purposes of this literature review, it

refers to any skills that an at-risk youth would benefit from in order to transition to adulthood

successfully. Buchert (2014), defined them as skills that sustained economic growth and allowed

individuals to lead autonomous lives in the 21st century, and Keenan et al. (2013), also noted the

importance of learning meta-cognitive skills in order to generalize learning to successfully cope

with challenges. Keenan et al. (2013) developed a life skills program that used the Canadian

Occupational Performance Measure (COPM), a semi-structured interview to determine a clients’

priorities for intervention and quantify their ability to perform an occupation as well as their
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 21

satisfaction with their performance. The COPM is a powerful tool in that it involves the client

directly in the process of goal setting, and it provides an outcome measure to confirm that

intervention is effective. After administering the COPM, they provided life skills coaching to a

total of 22 male and 28 female participants with the average age of 18.1 years with a variety of

disabilities that may be seen in the population at the YRC. They worked with each individual to

set personal goals, and participants attended group sessions as well as one-on-one sessions where

their personal goals were the focus of intervention. Topics covered were determined by the goals

set by the participants and included nutrition, money management, community mobility,

recreation, personal development, organizational skills, independent living, career planning, and

relationships (Keenan et al., 2013). Outcomes from the COPM showed that life skills

interventions provided statistically significant improvement for participants, and it was noted that

some participants preferred group activities where some preferred one-on-one sessions, but both

approaches were effective for the participants (Keenan et al. 2013).

By using an occupation-based standardized assessment to observe cognitive strategies in

action, it is possible to determine which clients would benefit from cognitive skills training to

improve executive function. Cognitive skills training as well as life skills training are highly

beneficial to improving outcomes for high risk youth. By using the WCPA in conjunction with

the COPM, goals can be set, and interventions tailored to the needs of the individual as well as

the group. OTs are well qualified to design programs to target the client factors, activity

demands, and occupations necessary to navigate the adult world successfully.

LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 22

Needs Analysis (Part 3)

Program Overview

Homeless youth are frequently unprepared for adult responsibilities. Those living in

shelters become accustomed to their needs being met by their case-workers and other adult

professionals. This leaves them unprepared to care for themselves when they no longer qualify

for services. At the YRC, clients age out of the provided programs on their 23rd birthday. This

life skills program will provide youth with the tools that are necessary to transition to adulthood

successfully. Services provided will include group activities as well as one-on-one sessions with

an occupational therapist. These services will support the YRC by adding additional structure to

their self-reliance program, and by providing the youth with opportunities to work one-on-one

with a skilled occupational therapist to pursue their goals.

Occupational Justice. Occupational justice was described by Stadnyk, Townsend, and Wilcock

(2010), as “meaningful and purposeful occupations (tasks and activities) that people want to do,

need to do, and can do considering their personal and situational circumstances’’ (p. 331).

Occupational injustice occurs when a person’s ability to participate in occupations is limited or

restricted due to a variety of circumstances. The type of occupational injustice most frequently

seen at the YRC is occupational depravation which occurs when people are unable to participate

in meaningful occupations due to factors they cannot control (Durocher, Gibson, & Rappolt,

2014). Being homeless limits opportunities for the youth at the YRC to explore areas of

occupational interest, because the clients there have limited resources available to them to pursue

meaningful occupations. Occupational marginalization also occurs at the YRC. This happens

when people have little choice in decision making or are held back from pursing meaningful

occupations by sociocultural factors including expectations for behavior (Stadnyk et al., 2010).
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 23

Often the social norms of the YRC that include substance abuse, and inappropriate behaviors do

not promote healthy or meaningful occupational engagement. This program will address

occupational injustice by providing the youth with opportunities to explore their occupational

needs through group activities and one-on-one occupational therapy sessions. The youth will be

provided with the resources and tools they need to break out of the cycle of occupational

depravation and occupational marginalization.

Role of the OT. Direct occupational therapy services will be provided to clients at the YRC

through an initial evaluation, group activities, and weekly one-on-one therapy sessions. These

services will focus on occupation-based goals that the clients identify through the COPM. The

most frequently identified goals will be utilized as topics for group activities, and goals that are

most important to an individual will be targeted in one-one-one sessions. Cognitive

rehabilitation will be integrated in both group settings, and with individuals. Indirect services

will also be provided by a youth advocate trained by the OT to assist with group activities.

OTs have a unique skill set making them the optimal professional to run a program of this

nature. They have a background that encompasses psychology, anatomy, cognition, and

sociology. OTs also have in-depth knowledge of activity analysis and motivational interviewing,

and are able to create treatment plans targeting a wide range of ability levels. In this setting, an

OT can help people with rehabilitative needs ranging from specific components of an activity to

complex instrumental activities of daily living (IADLs.)

Factors Influencing Service Delivery. Decisions regarding preferred service delivery were

influenced by multiple factors including demographics of the population served at the YRC and

policies already in place at the shelter. The cultural norms represented at the YRC, trauma

informed care, and potential for funding were all taken into consideration. Additionally,
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 24

economic implications such as the long-term financial burden that is possible when problems

specific to this population are not addressed were looked at. At-risk youth who do not gain the

skills necessary to succeed on their own are likely to remain homeless, participate in risky

behaviors, or adopt unhealthy habits as coping mechanisms (Shonkoff et al., 2012). This

program will act to prevent continued homelessness for clients at the YRC which will in turn

lessen the economic burden the homeless population has on the infrastructure of Salt Lake City

and the state of Utah. By reaching clients at this transitional time of their lives, future financial,

social, and health problems can be mitigated in a proactive way.

This program offers primary, secondary, and tertiary prevention for at risk youth.

Primary prevention is addressed by providing services to everyone regardless of current

occupational performance. Secondary prevention is addressed by providing extra cognitive

interventions to those who do not score within the normal range of the WCPA, and tertiary

prevention is addressed through one-on-one sessions for those who demonstrate significant

cognitive impairments. By addressing life skills and cognition with this population, we are

reducing their risk for continued homelessness, reducing their risk of substance abuse, and

providing interventions that will transfer to future interactions and situations for improved

occupational performance. For example, cognitive rehabilitation improves problem solving

abilities which helps increase occupational performance in a variety of situations and settings.

Theories and Practice Models.

The Person-Environment-Occupation (PEO) model will be the broad model utilized to

guide program interventions. This model is used to show that occupational performance emerges

from the transaction between people, the environment, and their occupations. This model

pertains to anyone that is not satisfied with their occupational performance due to a lack of
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 25

congruence between themselves, their occupations, and their environment (Law et al., 1996).

Right now, the clients served are not satisfied with their ability to perform a variety of tasks

necessary to live independently. PEO will be used to improve performance through adapting the

way occupations are completed, by modifying the environment to enable occupation, or by

teaching compenestory strategies. PEO provides a holistic approach that allows changes to be

made in multiple dimensions.

The complementary models that will be utilized are the Dynamic Interactional Model,

Kawa model, and the Lifestyle Redesign program. The Dynamic Interactional Model (DIM)

addresses how internal and external variables influence cognition and contribute to the efficacy

of the client’s occupational performance. The goals of this model are to decrease activity

limitations and enhance participation in everyday activities. This model addresses how people

process, learn, and generalize new information. Information processing skills as well as self-

efficacy will be addressed, and cognitive strategies will be integrated in treatment (Toglia, 2011).

The Kawa model will be used because it will resonate with the population at the YRC where

many of the clients there are interested in Eastern culture, and non-traditional spirituality. This

model uses a metaphor where life is represented by a river, obstacles are represented as rocks in

the river, and driftwood represents personal attributes. The Kawa model provides a powerful

visual tool for the youth to use to assess their current barriers to occupational success, and what

attributes they possess to increase their achievements (Kawa, 2009). Finally, Lifestyle Redesign

will be utilized because it provides a framework for health promotion with an underlying

foundation in occupational science. This program design lends structure to long-term

intervention and focuses on the importance of occupation as it applies to health and

psychological well-being. Though originally utilized for a well-elderly program, it can also be
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 26

used with other populations to build healthy habits and routines (Mandel, Jackson, Zemke,

Nelson, & Clark, (1999).

Program Goals and Objectives.

Goal 1. Clients will increase competency and satisfaction related to self-identified life skill tasks

that are necessary to function independently as an adult.

Objective 1. Within 12 weeks, 80% of clients will independently show a minimum of a 2-

point increase in satisfaction with at least two identified occupational problems on the

COPM through self-report.

Objective 2. Within 12 weeks, 80% of clients will independently show a minimum of a 2-

point increase in their performance regarding at least two identified occupational

problems on the COPM through self-report.

Goal 2. Clients will demonstrate overall improvement in executive function that will generalize

to improved performance of life skills tasks.

Objective 1. Within 12 weeks, 80% of clients will independently demonstrate the use of

at least one new additional strategy when completing the Weekly Calendar Planning

Activity as compared the first time they completed the WCPA.

Objective 2. Within 12 weeks, 80% of clients will independently score within 10% of a

control group on the Executive Function Performance Test (EFPT).

Control group scores provided with the EFPT.

Life Skills Training with Cognitive Rehabilitation. This program will ideally become part of

the programming already available at the YRC and run continuously in 12-week cycles that end

with a graduation ceremony. Group activities will be provided for two hours, twice a week, and

hour-long one-on-one sessions will be scheduled with participants on a weekly basis. The health
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 27

and wellness of participants will be addressed in sessions about self-care, navigating the health

care system, and preventing substance abuse. For those who would like to finish high school or

attend college, sessions can be held to help clients know what is necessary to finish their

education, and individual sessions can be used to not only learn ways to access education, but to

address client factors and performance skills that may be preventing academic success. As

needed or requested, social skills will be addressed, as well as participation in local government

as a voter. Since the clients will help guide topics addressed through their personal goals, any

topic of interest can be explored with an emphasis on skills that will increase independence.

All clients will be eligible to participate if they are interested in the program. Those who are

on an SRP will required to take part as part as part of the plan. In situations where program

capacity is at its limit, those on the SRP will be given priority eligibility over those who are not

participating in an SRP.

Time requirements. The following is a sample schedule for the program. Group outings and

activities will take place between 3:00-5:00 PM, during the time the YRC sets apart for group

activities that are already in place.

Monday: 2 hours for an outing relevant to Life Skills education (OTR and YA)

YA will assist OTR with the lesson/driving/keeping track of the youth

Tuesday: 3 hours for one-on-one sessions OTR

Wednesday: 3 hours for one-one-one sessions OTR

Thursday: 2 hour group session in the YRC (OTR and YA)

YA will assist the OTR with the session

Friday: 3 hours for one-on-one sessions OTR

LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 28

Additional 2 hours allotted to OTR is for planning/training staff

Additional 2 hours for YA for training/to assist with planning

The YRC currently provides a total of 30 beds for clients at night, with many more youth

spending time there during the day to access the resources provided by the facility. Those on a

SRP are guaranteed a bed at night as incentive to participate fully. The other 15 beds are divvied

out through a daily lottery system. Those who do not get a bed are required to sleep somewhere

else. Those who do not get beds stay with friends, use what money they have to get a motel

room, or sleep at the downtown library which is where the younger homeless population prefers

to stay. Most youth avoid the adult homeless population that gathers around Pioneer Park, and

the Road Home. They avoid these areas in part to evade violence, and to stay away from drugs

which are readily available in these areas.

Staff Involvement. Some staff members may be involved with the program by assisting with

group activities which will require extra training regarding occupation-based treatment. The

social workers on staff will advocate for this program to the clients who may choose to attend

based on their goals and interests and will require those on an SRP to attend. Anyone who is

interested in participating may do so and will be evaluated in order to establish personal goals.

These goals will then be used to guide group activities as well as individualized treatment plans.

Youth advocates who assist with group activities will be directly involved with the program for

approximately six hours per week. Social workers, and other employees will be educated on the

fundamentals of the program, which may take about an hour, and from there, minimal time will

be spent referring individuals. The occupational therapist will initially complete a COPM and

WCPA activity with clients. The most frequently identified occupational concerns will be

targeted in group activities, where other topics will be addressed in individual sessions.
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 29

Community resources will be utilized for outings. For example, banks, medical clinics,

restaurants, schools, and other facilities may be visited as part of a group outing. Professionals

from a variety of disciplines will also be asked to come teach the youth. A small budget will be

incorporated for group activities and to bring in guest speakers. Many professionals are willing

to provide pro-bono services to the YRC which will allow the budgeted funds to be utilized for

situations when a guest requires payment for time or travel. Currently, the YRC refers clients to

a variety of resources as part of their service model. This program will also strive to find

appropriate resources to provide the best outcomes for clients. It is difficult to determine exactly

which places and resources will be included in this program since the client goals will drive the

content.

Space Requirements. This program will require classroom space, office space, and a storage

area. The YRC already has multiple classrooms equipped with tables and chairs available for

use during group activities. They also have a large computer lab that can be reserved for use.

Preferably, the OT running this program would have a private office in order to meet with

client’s one-on-one and to store OT supplies separately from other supplies. At a minimum, the

OT would require access to a private room for treatment sessions and have an area in a locked

room set aside for storage. Space is not likely to become a concern for this program. The YRC

is located in as new, state of the art facility that was designed with growth in mind.

Budget. The net cost of this program is estimated to be $30,750. This includes supplies, a

budget for unexpected costs, salary for the OT, and hourly pay for a youth advocate. This

program will benefit from a part time OT on staff and includes an estimate to pay them for 15

hours a week to run this program. Youth advocates are already employed at the YRC, so it is

possible that this will not be an extra cost if they are able to provide one without hiring an
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 30

additional staff member. The YRC works as a non-profit entity with a robust community of

people that donate a wide variety of supplies that will be utilized for this program. See appendix

C for budget details.

Funding. Grant money may be available to fund this program. An advanced search on the

Foundation Directory On-Line using the key words “homeless, youth, occupational therapy, and

Salt Lake City” revealed that the George S. and Dolores Dore Eccles Foundation has grant

money available for homeless services as well as for health care related programs. The United

States Department of Health and Human services also provides numerous grants for homeless

services as well as healthcare related needs. Finally, Funding Institutional has grant money

available for a very specific program that involves cognitive rehabilitation. This program would

be required to be headed by a psych professional which would be possible through Volunteers of

America who employees professionals of this nature.

Marketing for the program will be done internally because the program is only available to

youth who access the services at the YRC. Employees will help market the program by referring

clients to it when they see that it would be beneficial for their personal growth, or as a

supplement to the SRP. The youth typically respect the staff at the YRC, and take suggestions

from them seriously, especially those who are on an SRP since participating in that program can

lead to housing vouchers. Additionally, posters and announcements about the program and what

it offers the clients will be displayed within the facility. Overall, this program will be well

attended because it was written in response to direct feedback provided by the clients who are

currently accessing services through the YRC.

Expected Outcomes. The literature strongly suggests that this program will have a significant

positive impact on performance of life skills as well as cognition. Participants will leave the
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 31

program better prepared for adult responsibilities and have the skills to generalize information to

novel tasks, and improved problem-solving skills. Outcomes will be measured through the

program goals and objectives. Efficacy of the program will be demonstrated by improved scores

on the COPM as well as WCPA and EFPT scores. In addition to the quantitative data that will

be determined through the goals and objectives, clients will be surveyed regarding their opinion

of the program and this feedback will be implemented to improve the quality of the program.

Possible questions include:

 What was your favorite thing about this program?

 What do you think we could do better?

 What topics were not addressed that you feel should have been?

 If you could change one thing about the program, what would it be?

This program has the potential to be highly beneficial to the youth at the YRC, and if

implemented it would provide additional structure to the programs already in place. Through

participation, not only will they be more prepared for stepping into adult roles, they will also be

less likely to participate in risky behaviors.

LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 32

Appendix A: Interview Questions

Staff questions
 Do you see any common client needs that are not being adequately met?
 Do you see any ways that OT could enhance your current programs?
 What do you find most challenging about your job?
 Is there a lot of employee turnover?
 How do you protect your own mental health while working with this population?
 What is the purpose of your organization? (Mission statement, philosophy, etc.)
 What group of individuals do you serve?
 What are some of the characteristics of this group? Diagnoses, LOS, what other services
do they usually get
 What are your funding sources?
 What kinds of programming/services do you currently offer?
 What are plans for different or additional services, etc. in the future?
 Based upon your knowledge of your clients and how they function in your program or
after they leave, what gaps do you see in their functioning or skill levels?

Client questions

The COPM was administered to the client first, then the following questions were asked if not

answered in the COPM process.

 What brought you to the YRC?

 Have you been diagnosed with any specific disorder?
 How long have you been here?
 What does the YRC do well?
 Is there anything you feel the YRC could do better?
 Do you have any children?
 What are your current goals in life?
 What does a typical day look like for you?

Appendix B: COPM sample

LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 33
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 34
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 35
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 36

Appendix C: Line-Item Budget Detail

Source of Specific costs or sources of Cost

income
Start-up Costs COPM App $10 to activate and $42 to use $52
300 times
Weekly Calendar Planning Activity $99
Executive Function Performance Test $30
Assessment is free, supplies are estimated
at $30 if purchased at a dollar store and a
thrift store
Computer with windows office for OTR $800
In kind donation Office space in the YRC $0
In kind donation Treatment space at the YRC $0
In kind donation Van for outings $0
Total= $800
Direct Costs Part Time OTR 15 hrs per week at $30/hr $23,400
This is slightly below the Utah average of
$34.67 for a part time OT shown on
ziprecruiter.com
In kind donation Office Supplies $0
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 37

In kind donation Supplies for group activities (can be $1,000

with a small anything from food for a cooking activity to
budget for pens/paper, however many of these items
supplies that will be available for use in-kind. This is just
may not be to cover what might not be there)
available on-
site
In kind donation Cost associated with some outings, but $1,000
most will not include an additional fee.
Most likely use of this budget will be for
admission fees to events or places such as
museums.
In kind donation Budget to bring in guest speakers and $250
with a small experts to address specific life skills, due to
budget for the nature of the location, most experts will
guests who are be able to donate their time
unable to
donate their
time
Support Staff- youth advocate already $3,900
employed there.

Total= $30,750
Indirect Costs These expenses will be covered by the $0
YRC as in-kind donations. Items include
building maintenance, utilities

Income

Budget
Summary
Total costs
$30,750

Total income or
in-kind
contributions
Net cost of
program
$30,750

Total= $30,750
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 38

Office space, treatment space, and vehicle

use will be provided in-kind by the YRC
LIFE SKILLS TRAINING TO PROMOTE INDEPENDENCE 39

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